Monday, June 20, 2011

Go and reach into your pockets, or extricate your fingers from your bag pocket and if your finger(s) does not lock on you or does not give a catch, you're lucky. I am not saying that trigger finger is the norm but my sisters, my friends have them and it's starting to be a little too common. This reminds me of an asthmatic friend who at a party asked me if I brought with me a nebulizer. "What", I asked, although the term is not foreign to me, as my daughter used to have asthma before. Our other friends laughed, reminded the inquiring friend, "You're the only asthmatic person here, why should we have nebulizers in our bags?. You made it sound like we're not normal if we don't have it in us."

What is a trigger finger? Trigger finger is a condition that affects the tendons in your fingers or thumb. It is also known as trigger digit or stenosing tendovaginitis. According to Wikipedia, "trigger finger, trigger thumb, or trigger digit, is a common disorder of later adulthood characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. A disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level of the first annular (A1) pulley, results in difficulty flexing or extending the finger and the “triggering” phenomenon. The label of trigger finger is used because when the finger unlocks, it pops back suddenly, as if releasing a trigger on a gun." It limits finger movement and it's so painful, especially when it's locked. You have to massage it slowly to unlock or uncurl it or you have to soak your hand in warm water.

What causes trigger finger?
I am a hardworking person. Since I was a small girl I was the 'kargador' of my grandmother and my aunts. I was the youngest and smallest 'working' member of that family, but I was chosen to be the one to carry everyone's shopping bags, not only the ordinary grocery bags but also the bags of merchandise that my aunt bought and sold to the whole neighborhood. I felt like Supergirl or Wondergirl those days. I thought that I had 'special power' as I could lift better than my peers. With that kind of mentality, when I grew up and became an office employee later, I lifted boxes of files, typewriters, etc. When I became a photographer specializing in interiors and furniture photography, I felt comfortable lifting big sofas, chairs and even beds. I did not heed people's advice to go easy on my hands, my fingers, my arms. In fact I made myself stronger by lifting weights - barbells, dumb bells, way before going to the gym became fashionable. That's my theory of the root cause of my trigger fingers. Added to that, another friend's theory is that I always touched hot objects like lids of pots and pans while cooking without using a pot holder to protect my fingers from the heat, then while 'resting' as my dish is simmering or boiling, I go right ahead and wash the dishes on the sink with cold water (no hot water system in our house then). Did I not tell you I thought I had super powers?

What really causes trigger finger?

According to this site, http://www.davidlnelson.md/Trigger_Finger.htm, these are the causes of trigger finger:

We do not know exactly what causes trigger finger, but we do know some things. The tendon is subjected to significant forces at the A1 pulley, which is where trigger finger occurs. Trigger fingers show changes in the substance of both the tendon and the pulley called "fibrocartilaginous metaplasia", which means that some of the cells change into cells that have the characteristics of cartilage cells such as those found in inter vertebral disks. The cells show an increase in both the size of the cells and the number of cells. The smooth gliding layer of the tendon and the pulley change, with fraying and disintegration of the surface. We do not see these high forces or cellular changes in other areas of the flexor tendons, therefore we feel that these changes must be related to the disease called trigger finger. (Trigger Digits: Diagnosis and Treatment, by Miguel J. Saldana, MD; Journal of the AAOS, July/August, 2001, pages 246-252).

The normal tendon is composed of very parallel strands of collagen.
The trigger nodule has degredation products of collagen
accumulating within the strands of collagen inside the tendon,
creating a fat place or "nodule" in the tendon. (illustration by Dr. Nelson)

The nodule inside the tendon can grow so big
that it cannot pass under the pulley.

In addition, the molecules of the collagen (collagen makes up about 95% of the substance of a tendon) degrade and break up. The degradation products of the collagen, called "mucinous degeneration", accumulate within the tendon, enlarging the area (see illustration, below). This in part creates the bump or swelling of the tendon. This seems to be a natural part of aging (like gray hair and wrinkles) and is not a sign of disease or overuse. That is, we do not see trigger nodules more commonly in people who do heavy manual labor for a living and we do not see it more commonly in the dominant hand, even though we all use our dominant hand much more than our non-dominant hand. Trigger nodules are most commonly seen in adults of middle age, especially post-menopausal women and men of a similar age.

It's hard for me to understand fully the goobledigook above, how about you?

I agree with them on this, though, a doctor's view: Who gets trigger finger?

Many people think trigger finger should come from a long history of hard work, but hard labor does not seem to be very related. It can come from an episode of overuse, but is usually not associated with any period of heavy use. It usually comes on gradually, and typically comes in our 40's, 50's, and 60's. It is about two to three times more common in women than in men, and the fourth finger is the most often involved. It is common for patients to get it in more than one finger. If they do, it is often either the same finger in both hands, or two adjacent fingers. I have only had one patient who had it in all 10 fingers, and he was a 60 year old who played handball. I think if you are 60 and go around whacking things with your palm, you should expect to get problems! Most patients will get it in only one or two fingers.

So what could be done for treatment?
The first step to recovery is to limit activities that aggravate trigger finger. Occasionally, your doctor may put a splint on the affected hand to restrict the joint movement. If symptoms continue, anti-inflammatory medications, such as ibuprofen or naproxen, may be prescribed. Your doctor may also recommend an injection of a steroid medication into the tendon sheath. If the condition does not respond to conservative measures or consistently recurs, surgery may be recommended to release the tendon sheath and restore movement.

Would you like to see how the surgery is done?

I had my first surgery on my right thumb. After two years, I had my middle finger operated too, and recently and the worst ever, I had my forefinger operated. As you can see, I have two cuts for my middle finger surgery. After the first cut and the doctor's usual procedure (see above video), Doc asked me to curl my middle finger. There was still a 'catch' so he made another cut and did his procedure again. With my recent forefinger surgery, the doctor made me curl my forefinger after the procedure. There was still a catch, so he made the cut wider, and did his procedure again. Then, he asked me again, and hayst, there was still a catch. We repeated this exercise four times! Ouch, ouch, ouch, ouuuchhhhh! Yes, I had local anesthesia, but I could feel the heaviness and I felt how my palm was poked repeatedly; and of course the tourniquet got painful and very uncomfortable. Yes, Prescilla, the doctor ties a tourniquet on your upper arm to minimize blood letting, it could be messy, you know.

My poor right hand, veteran of three trigger finger surgeries.

What are the possible complications of a trigger finger release?
Trigger finger surgery is very safe, but there are possible complications. The most common problem is that the trigger finger can come back if the tendon sheath is not adequately released. Other possible problems include infection, stiffness of the finger, and damage to the nerves of the finger. The likelihood of these problems is very small, and trigger finger surgery has a very high success rate.

Exercises for trigger finger:
This site offers good exercise for trigger finger:
http://www.ehow.com/list_6902465_alternative-finger-exercises.html

Flex Finger Exercise

To gain flexibility and strength in your fingers, sit at a table, resting elbows and forearms comfortably on the surface. Test your degree of flexibility by trying to touch the ends of your fingers to your palm, then straightening them out again. If this is not possible, approach the task slowly by straightening each finger individually, starting with the easiest one to move and building it up by adding another finger every few days, as the previous one gains strength. As with all exercise, proceed slowly, halting if you experience any pain. Carry out all exercises under the direction of your health care provider.

Bend and Straighten Fingers

To bend and straighten your fingers, either all together or one at a time, begin with the joint nearest the nail. Keeping the palm straight and using the other hand to help if necessary, try to bend the first joint in towards the palm. Follow with bending in the middle joint and finish with the knuckle joint. Repeat for each finger. Switch hands and do the same routine, using the spare hand as an aid if you need to. Make these exercises part of your regular routine by scheduling them at a convenient time and try not to miss a day, since frequency is a big factor in the success of any regime.

Thumb Exercise

While sitting comfortably, extend your wrist straight out in front of you, palm up. Supporting your forearm with a table top or the other hand, if necessary, touch the tip of your thumb to the top of your index finger to form the letter"O." Repeat with each finger and then move on to the other hand, pausing to straighten and spread the fingers between each letter.

Little Finger Exercise

Sit in an upright chair at a dining table or office desk. Place your forearm flat on the table top with the palm facing down. Gradually turn and raise your hand, beginning with the thumb, leaving your little finger in contact with the table's surface. Use your other hand to support the hand performing this exercise by gripping about mid-forearm, not at the wrist.

It took one year for each of my fingers to feel good as new. I hope and pray that my latest surgery be as successful as the first two, whew! And you, take care of your hardworking hands.References:
http://www.blogger.com/post-create.g?blogID=439018831876850134
http://en.wikipedia.org/wiki/Trigger_finger
http://orthopedics.about.com/cs/handcondiitions/a/triggerfinger_2.htm

Do you think you have trigger finger(s)? If it's in an early stage, this product might help you!

Product Description
The TFS provides a pad over the A-1 pulley to relieve pressure during daily activities without interfering with hand function. It cushions the fat pad at the base of the finger and may completely reverse the trigger finger, making more aggressive treatments unnecessary. The TFS also assists in identifying the cause of the inflammation, which is often handling of certain objects. For size measure finger circumference mid-way between the base of the finger and the PIP joint. Due to anatomical differences or swelling, a larger size may be necessary.